RECORD OF ESTIMATED AND ACTUAL INCOME

Barangay: City/Municipality:
Barangay Treasurer: Province:

Date Particulars Reference No. Total

A.        Income Estimates

B.        Actual Collections
D ACTUAL INCOME
Page No.:

Income Accounts
 RECORD OF APPROPRIATIONS AND OBLIGATIONS
Barangay: City/Municipality:
Chairman on Committee on Appropriations: Province:
Fund Source:

Reference Personnel Services Maintenance & Other Operating Expe

Total
Date No.
A.        
Appropriations

B.        Obligations
LIGATIONS
Page No.:

er Operating Expenses Financial Expenses Capital Outlay

 Barangay __________________
Bato, Leyte
Statement of Appropriations, Obligations and Balances
As of ___________________
(In Philippine Peso)

Appropriations
Function/Program/Project Obligations Balances
Code Original Supplemental Final
I.     Current Year Appropriations
Personnel Services
Maintenance and Other Operating Expenses
Financial Expenses
Capital Outlay

20% Development Fund

10% Sangguniang Kabataan Fund
5% LDRRMF

II.   Continuing Appropriations
Capital Outlay
20% Development Fund
Certified Correct: Noted By:

__________________________________ ________________________________
Chairman, Committee on Appropriations Punong Barangay

____________________ ____________________
Date Date
 REGISTRY OF SPECIAL TRUST FUND
Barangay: City/Municipality: Page No.:

Chairman on Committee on Appropriations: Province:

Purpose:
Details of Appropriations Details of Charges
Date Particulars Ref. Amount Year
-1 -2 -3 -4 -5 -6 -7 -8 -9 -10
e No.:

-11
 REPORT OF COLLECTIONS AND REMITTANCES

Name of Collecting Officer: ________________ Date: ____________

Barangay: _____________________________ RCR No.: _________
City/Municipality: ________________________
Province: ______________________________

A. COLLECTIONS
Official Receipt
Payor Nature of Collection Amounts
Date Number

TOTAL
B. SUMMARY OF COLLECTIONS

List of Checks
Beginning Balance _____________ 20 ___ P
Add: Collections Check No. Payee Amount
Cash
Checks
Total

C. ACCOUNTABILITY FOR ACCOUNTABLE FORMS

Beginning Balance Receipt Issued Ending Balance
Name of Form and No. Inclusive Serial No. Inclusive Serial No. Inclusive Serial No.
Qty Qty Qty Qty
From To From To From To From To
With Money Value:
Cash Tickets

Without Money Value:

Official Receipts

D. CERTIFICATION: E. ACKNOWLEDGMENT:

I hereby certify that the foregoing Report of Collections and Remittances and
I hereby certify that this Report of Collections and Remittances; and Accountable Forms
Accountable Forms including cash and supporting documents have been
including supporting documents are true and correct received.

___________________________ ____________ _______________________ ___________

Deputized Barangay Collector Date Deputized Barangay Collector Date
 REPORT OF COLLECTIONS AND DEPOSITS

Name of Barangay Treasurer: ________________________ Date: _________________

Barangay: ________________________________________ RCD No.: ______________
A. COLLECTIONS

Official Receipt/RCR
Payor Nature of Collection Amounts
Date Number

TOTAL
B. DEPOSITS
Bank/Branch Reference Amount

TOTAL
C. ACCOUNTABILITY FOR ACCOUNTABLE FORMS
Beginning Balance Receipt Issued Ending Balance

Name of Form and No. Inclusive Serial No. Inclusive Serial No. Inclusive Serial No. Inclusive Serial No.
Qty Qty Qty Qty
From To From To From To From
With Money Value:
Cash Tickets

Without Money Value:

Official Receipts

D. CERTIFICATION:

I hereby certify that this Report of Collections and Deposits; and Accountable Forms including supporting documents are true and correct

_____________________ ___________
Barangay Treasurer Date
E. ACCOUNTING ENTRIES
Account Title Account Code Debit Credit

Prepared by: Ronie M. Gesurem Approved by: Maria Roquesa J. Saveron, CPA
Barangay Bookkeeper Municipal Accountant
alance

sive Serial No.

To
Credit
 CASHBOOK
Barangay: ________________________________________
Barangay Treasurer: ________________________________
Calendar Year: ____________________________________

Cash in Local Treasury Cash in Bank

Date Particulars Reference Check
Collection Deposit Balance Deposit Balance
Issued

CERTIFICATION

I hereby certify that the foregoing

deposits/remittances and balances
Cash Advances, and Petty Cash a
 Cash Advance Petty Cash
Disburse- Receipt/
Receipt Balance Payments Balance
ments Replenishment

FICATION:

foregoing is a correct and complete record of all my collections,

d balances of my accounts in the Cash – In Local Treasury, Cash in Bank,
tty Cash as of _________________.

___________________
Name and Signature

____________
Date
 REPORT OF ACCOUNTABILITY FOR ACCOUNTABLE FORMS
For the Month of _________, 20____

Barangay: _______________________________ City/Municipality: ________________

Barangay Treasurer: _______________________ Province: ______________________

Beginning Balance Receipt

Name of Form Inclusive Serial Nos. Inclusive Serial Nos.
QTY QTY
From To From To
A. With Money Value
Cash Tickets

B. Without Money Value

Official Receipts
Checks

CERTIFICATION:
I hereby certify that the foregoing is a true statement of all accountable forms received, issued and
transferred by me during the above-stated period and the correctness of the beginning balances.

__________________________________ __________________
(Name and Signature) Date
Barangay Treasurer
R ACCOUNTABLE FORMS
___, 20____

________ RAAF No. ________________

________

Issued Ending Balance

Inclusive Serial Nos. Inclusive Serial Nos.
QTY QTY
From To From To

d and
s.
 Disbursement Voucher

Barangay: City/Municipality:  DV No. :

Payee:  Province:   Date :
Address:  TIN :   Fund:
Particulars Amount

A. Certified as to existence of B. Certified As to availability of  C. Certified as to validity,

appropriation for obligation funds for the purpose, and propriety, and legality of claim and
completeness and propriety of approved for payment:
supporting documents

_______________________ _________________________ _________________________

(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)
Chairman, Committee on Appropriation Barangay Treasurer Punong Barangay
Date : ____________ Date : _____________ Date : ______________
D. Received Payment:
Check No.:
___________________________ Bank Name:__________ Date: __________
Signature Over Printed Name OR No.: _____________

E. Accounting Entries
Account Account Code  Debit Credit

Prepared By:

RONIE M. GESUREM ______________

Barangay Bookkeeper Date

Approved By:

MARIA ROQUESA J. SAVERON, CPA _______________

Municipal Accountant Date
 ACKNOWLEDGEMENT RECEIPT FOR DONATED PROPERTY, EQUIPMENT,
SUPPLIES AND MATERIALS

Barangay : Date :

Province/City/Municipality : ARDPESM No.:

Donor’s Name :

Authorized Representative :
Address:
Quantity Unit Description

Total

Purpose of Donation:

 
Received the donated articles for the purpose stated above.

Printed Name and Signature of the Punong Barangay/

Authorized Representative

Conforme:

Printed Name and Signature of the Donor/

Authorized Representative
ERTY, EQUIPMENT,

Value
 STOCK CARD
Supplies: Supplies Number:

Description:
Issuance
Date Reference Quantity Received
Quantity Received by
umber:

Balance
 REQUISITION AND ISSUE SLIP 

Entity Name :

Division : _______________________________________________ Responsibility Center Code : ______
Office : ________________________________________________ RIS No. : 
Requisition Stock Available?
Stock No. Unit Description Quantity Yes No
   Purpose:

Requested by:    Approved by: Issued by:

Signature :
Printed Name :
Designation :
Date :
AO 6/15/02
 Appendix 63

E SLIP 

Fund Cluster : 

ponsibility Center Code : ______________________

Issue
Quantity Remarks
Issued by: Received by:
 INVENTORY CUSTODIAN SLIP

Barangay: City/Municipality: ICS No.:

Tel. No.: Province:

Estimated
Quantity Unit Description
Useful Life

Received by: Issued by:

(Signature over Printed Name) (Signature over Printed Name)

Recipient Barangay Treasurer

____________ ____________
Date Date
 INVENTORY CUSTODIAN SLIP

Barangay: City/Municipality: ICS No.:

Tel. No.: Province:

Estimated
Quantity Unit Description
Useful Life

Received by: Issued by:

(Signature over Printed Name) (Signature over Printed Name)

Recipient Barangay Treasurer

____________ ____________
Date Date
 SUMMARY OF SUPPLIES AND MATERIALS ISSUED

__________________________________________
Barangay, City/Municipality, Province

For the Period _________________ to __________

No.:

Requisition and Issue Slip Numbers Total

ITEM Unit of
Quantity Issued Quantity Unit Cost Total Cost
Measurement
No. Description -1 -2 -3 -4 -5 -6 -7 -8 -9 -10 -11 Issued

Prepared by: Certified by: Posted in the SLC by/date:

_______________________ _______________________ _______________________

Clerk Supply Officer Accounting Clerk
 REPORT ON INVENTORY OF SUPPLIES AND MATERIALS
As of ______________________

Barangay: City/Municipality: 
Tel. No.: Province: 

(Date of Assumption)
For which ________________________  ___________________ is accountable, having assumed accountability on _______________
(Name of Accountable Officer) (Official/Desination)

ON HAND  SHORTAGE/ OVERAGE
STOCK  UNIT OF  UNIT  BALANCE PER 
ARTICLE DESCRIPTION PER COUNT  REMARKS
NUBMER MEASURE VALUE CARD (Quantity)
(Quantity)
Quantity Value

Prepared by: Approved by:

Signature over Printed Name Signature over Printed Name Signature over Printed Name

             Barangay Treasurer          Punong Barangay or Representative                                Punong Barangay                 
Member, Inventory Committee Chairman, Inventory Committee

_______________ _______________ _______________

Date Date Date
 REMARKS

er Printed Name
arangay                 

_________
Date
Barangay: PROPERTY ACKNOWLEDGEMENT RECEIPT Barangay: PROPERT
City/Municipality: PAR No.:
Tel. No.: Province: Tel. No.:
Quantity Unit Description Property No. Date Acquired Cost Quantity

Received by: Issued by: Received by:

____________________________ ____________________________ _____________________

Signature over Printed Name Signature over Printed Name Signature over Printed
Recipient/User Barangay Treasurer Recipient/User

_________________ _________________ _______________

Date Date Date
 PROPERTY ACKNOWLEDGEMENT RECEIPT
City/Municipality: PAR No.:
Tel. No.: Province:
Unit Description Property No. Date Acquired Cost

Received by: Issued by:

____________________________ ____________________________
Signature over Printed Name Signature over Printed Name
Recipient/User Barangay Treasurer

_________________ _________________
Date Date
 PROPERTY/EQUIPMENT CARD
______________________________________
Barangay, City/Municipality, Province

Property NO.
Property/Equipment: Property/Equipment:
Location: Location:
Description: Classification: Description:

Date of Purchase Particulars Cost Improvement/Repairs Transfers/etc. Total Date of Purchase

 PROPERTY/EQUIPMENT CARD
______________________________________
Barangay, City/Municipality, Province

Property NO.
uipment:

Classification:

Particulars Cost Improvement/Repairs Transfers/etc. Total

 Report on Inventory of Property and Equipment
As of ___________________________

Barangay: City/Municipality:
Tel. No.: __________________________ Province:

For which _________________________________ is accountable

(Name of Accountable Officer)(Official Designation)

Property Balance On Hand Shortage/Overage

Unit of
Article Description /ICS Unit Value PEC per count
Measure
Number (Quantity) (Quantity) Quantity Value
Part A – Property and equipment covered by PAR

Part B – Property and equipment covered by ICS

Prepared by: Approved by:

________________________
Signature over Printed Name
Barangay Treasurer
Member, Inventory Committee
__________________________
_____________________________
Signature over Printed Name Signature over Printed Name
Punong Barangay or Representative Punong Barangay
Chairman, Inventory Committee

__________________ __________________
Date Date
 Remarks

________
Name
y

__
 BIOLOGICAL ASSETS PROPERTY CARD

Barangay: __________________________________________
Accountable Officer: _________________________________

Biological Asset :
Description :
Additions Reductions
Date Reference Purchase Birth Sale Transfer Death
Qty. Qty. Qty. Qty. Selling Price Qty. Qty.
RTY CARD

City/Municipality: ___________________________
Province: _________________________________

BAPC No.

Balance
Fair Value Remarks
Qty. Qty. Amount
 QUARTERLY REPORT OF BIOLOGICAL ASSETS
________________________________________
(Type of Biological Asset)

As at _______________________

Accountable Officer: Barangay: Province:

Official Designation: City/Municipality:

Balance Per Card Additions Reductions Balance Per Card

BAPC No. Description Per Last Report Purchase Birth Price Adustment Total Sale Death Total End of the Period Remarks
Cost/ Fair  Cost/ Fair  Cost/ Fair  Cost/ Fair 
Qty. Fair Value Qty. Cost Qty. Fair Value Qty. Qty. Qty. Selling Price Qty. Fair Value Qty. Qty. Qty. Fair Value
Value Value Value Value
 PAYROLL
Period  Covered:  _______________________

Barangay:  __________________________________ City/ Municipality: __________
Barangay Treasurer:  __________________________ Province: _________________

Compensation
No. Name Position Salaries &  Other 
Honoraria
Wages Benefits

A. Certified as to availability of appropriation for  B. Certified as to availability of funds and  C. Certified as to validity, proprie

obligation in the amount of ____________. completeness and propriety of supporting documents. claim and approved for payment.

Signature:  ___________________ Signature:  ____________________ Signature:  __________________

Printed Name: Printed Name: Printed Name:
Position: Chairman, Comm. On Appropriations Position:  Barangay Treasurer Position: Punong Barangay
Date: Date: Date:

E. Accounting Entries
Account Title Account Code Debit
LL
_______________

__________ Payroll: ___________________
__________

n Deductions Net 
BIR  Amount  Signature of Recipient
Total withholding  Total
Tax Due

fied as to validity, propriety, and legality of  D. Certified that each official/ employee whose name 
d approved for payment. appears on the above roll has been paid the amount stated 
opposite his name.

e:  _____________________ Signature:  _____________________
Name: Printed Name:
: Punong Barangay Position: Barangay Treasurer
Date:

Debit Credit Prepared By:

RONIE M. GESUREM _______
Barangay Bookkeeper Date
Approved by:

MARIA ROQUESA J. SAVERON, CPA _______
           Municipal Accountant Date